Does the COVID-19 pandemic condition the delusional content of patients with psychosis? An observational study.

INTRODUCTION: The primary objective is to analyse the impact of the COVID-19 pandemic on the triggers of psychopathology and on the delusional content of patients with psychotic symptoms treated during the first three months of the pandemic in a tertiary hospital in Madrid. METHODS: We conducted a cross-sectional, observational and retrospective study of all patients attending the psychiatric emergency room (ER) between 11th March and 11th June 2020. Sociodemographic and clinical variables were included. The chi-squared test or Fisher's exact test were performed to compare categorical variables. The level of statistical significance was set at P<.05. RESULTS: In the first month of the pandemic, COVID-19 conditioned the delirious content of 38.5% of the admitted patients and acted as a direct trigger for 46.2% of consultations. In the second week it affected 100.0% of the patients in both cases. Subsequently, a progressive and significant decrease was observed, with COVID-19 being the triggering factor for 17.6% and 11.5% of consultations in the second and third months of the pandemic respectively. Similarly, it was the main determinant of the delusional content in 13.7% and 3.8% of cases respectively. CONCLUSIONS: The current pandemic affects delirium's pathoplasty. The delusional content of patients admitted with psychotic symptoms is quickly conditioned, which may be related to the radical change in their life, without transition or prior preparation. The patient's environmental context and events have a huge impact on the dynamics and characteristics of mental disorders.

[Does the COVID-19 pandemic condition the delusional content of patients with psychosis? An observational study]. / ¿La pandemia de COVID-19 condiciona el contenido delirante de los pacientes con psicosis? Un estudio observacional.

Introduction: The primary objective is to analyse the impact of the COVID-19 pandemic on the triggers of psychopathology and on the delusional content of patients with psychotic symptoms treated during the first three months of the pandemic in a tertiary hospital in Madrid.Methods: We conducted a cross-sectional, observational and retrospective study of all patients attending the psychiatric emergency room (ER) between 11th March and 11th June 2020. Sociodemographic and clinical variables were included. The chi-squared test or Fisher's exact test were performed to compare categorical variables. The level of statistical significance was set at p<0.05.Results: In the first month of the pandemic, COVID-19 conditioned the delirious content of 38.5% of the admitted patients and acted as a direct trigger for 46.2% of consultations. In the second week it affected 100.0% of the patients in both cases. Subsequently, a progressive and significant decrease was observed, with COVID-19 being the triggering factor for 17.6% and 11.5% of consultations in the second and third months of the pandemic respectively. Similarly, it was the main determinant of the delusional content in 13.7% and 3.8% of cases respectively.Conclusions: The current pandemic affects delirium's pathoplasty. The delusional content of patients admitted with psychotic symptoms is quickly conditioned, which may be related to the radical change in their life, without transition or prior preparation. The patient's environmental context and events have a huge impact on the dynamics and characteristics of mental disorders.

Análisis de la demanda asistencial en la urgencia y unidad de hospitalización psiquiátrica en el contexto de pandemia por COVID-19 / Analysis of the demand for care in a psychiatric emergency room and an acute inpatient unit in the context of the COVID-19 pandemic

INTRODUCCIÓN: El objetivo consiste en analizar el impacto del COVID-19 en la demanda asistencial de las urgencias y en los ingresos psiquiátricos durante el primer mes de la pandemia. MÉTODOS: Realizamos un estudio transversal observacional retrospectivo en pacientes que acuden a urgencias psiquiátricas entre el 11 de marzo y el 11 de abril de 2019 y 2020 respectivamente. Se incluyeron variables sociodemográficas y clínicas en el estudio. Se realizaron las pruebas de Chi Cuadrado o Test exacto de Fisher para el contraste de hipótesis de variables categóricas y la prueba U Mann-Whitney para el contraste de variables cuantitativas. El nivel de significación estadística se estableció en p<0.05. Los análisis se realizaron con IBM SPSS Statistics. RESULTADOS: Se observa un descenso significativo de la media de pacientes atendidos al día en urgencias entre ambos periodos, siendo esta de 5,91 (±2,53) en 2019 y de 2,41 (±1,81) en 2020 (p<0.001). Se ha visto una disminución significativa de la ocupación media de camas en la UHB, ocupándose un 91,84% (±7,72) de camas en 2019 y un 58,85% (±13,81) en 2020 (p<0,001). En cuanto a la proporción de ingresos de los pacientes que acuden a urgencias, se ha visto un aumento significativo en el año 2020 respecto al año anterior. CONCLUSIONES: La demanda en la urgencia de pacientes psiquiátricos y la ocupación media de camas se ha reducido durante el primer mes tras la declaración de la pandemia. El miedo al contagio puede actuar como modulador de la demanda psiquiátrica.

INTRODUCTION: The aim is to analyze the impact of COVID-19 on the demand for emergency care and psychiatric admissions during the first month of the pandemic. METHODS: We conducted a retrospective, observational and cross-sectional study. We reviewed the clinical records of all patients attending the psychiatric emergency room (ER) between March 11th and April 11th, of both 2019 and 2020. Sociodemographic and clinical variables were included in the study. Chi-square test or Fisher's exact test were performed to compare categorical variables, while U Mann-Whitney U test was used for quantitative variables. The level of statistical significance was set at p<0.05. Analysis were conducted using IBM SPSS Statistics. RESULTS: The was a significant decrease in the number of patients attended in the ER. An average of 5.91 (±2.53) patients were treated per day in 2019 compared to 2.41 (±1.81) in 2020 (p<0.001). There was also a significant decrease in the occupancy rate at the inpatient psychiatric unit, with a 91.84% (±7.72) of beds occupied in 2019 and only 58.85% (±13.81) in 2020 (p<0.001). Regarding the percentage of patients admitted after assessment in the ER, there was a significant increase in 2020 compared to the previous year. CONCLUSIONS: The demand for care in the psychiatric emergency room and the average bed occupancy have decreased during the first month after the declaration of the pandemic. Fear of contagion may act as a modulator of psychiatric demand.

The Role of Anxiety in Patients With Persistent Atrial Fibrillation Undergoing Elective Cardioversion: An Observational Study.

OBJECTIVE: Anxiety is often present among patients with atrial fibrillation (AF). This condition has been associated with greater symptom severity and worse quality of life in these patients. However, the influence of anxiety on the risk of AF recurrence is not well known. We aimed to define the level of anxiety in patients with persistent AF undergoing elective cardioversion (EC) and determine whether there is an association between anxiety and the risk of early AF recurrence after EC. METHODS: Anxiety was measured before EC using the State-Trait Anxiety Inventory. Early AF recurrence was assessed with a control electrocardiogram at 30-day follow-up. RESULTS: We included 107 patients undergoing effective EC. Early AF recurrence was diagnosed in 40 patients (37.4%). Compared with those who remained in sinus rhythm, individuals with early AF recurrence had significantly higher levels of trait anxiety (23.1 [10.4] versus 17.9 [9.5]; p = .013) and larger left atrial volume index (45.8 [12.3] versus 37.9 [13.3] ml/m; p = .004). Both variables remained independently associated with early AF recurrence after multivariate analysis. A predictive model including trait anxiety score >20 and left atrial volume index >41 ml/m showed acceptable accuracy for the diagnosis of early AF recurrence (area under the curve = 0.733; 95% confidence interval = 0.634-0.832; p < .001). CONCLUSIONS: Our study shows that trait anxiety is an independent risk factor for early AF recurrence after EC. Further studies are warranted to assess the beneficial role of anxiety-reducing strategies on the outcomes of patients with AF.

Descriptive analyses of the aripiprazole arm in the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE).

A recent randomized, open-label, relapse prevention trial (ConstaTRE) compared outcomes with risperidone long-acting injectable (RLAI) versus the oral atypical antipsychotic quetiapine. This study also included a small descriptive arm in which patients could also be randomized to aripiprazole. Results of this exploratory analysis are described here. Clinically stable adults with schizophrenia or schizoaffective disorder previously treated with oral risperidone, olanzapine, or an oral conventional antipsychotic were randomized to RLAI or aripiprazole. Efficacy and tolerability were monitored for up to 24 months. A total of 45 patients were treated with aripiprazole (10-30 mg/day) and 329 patients with RLAI (25-50 mg i.m. every 2 weeks). Relapse occurred in 27.3% (95% CI: 15.0-42.8%) of aripiprazole-treated and 16.5% (95% CI: 12.7-21.0%) of RLAI-treated patients. Kaplan-Meier estimates of mean (standard error) relapse-free period were 313.7 (20.4) days for aripiprazole and 607.1 (11.4) days for RLAI patients. Remission was achieved by 34.1% (95% CI: 20.5-49.9%) of aripiprazole and 51.1% (95% CI: 45.5-56.6%) of RLAI patients. Clinical global impression-change was improved ("minimally improved" to "very much improved") in 26.4% with RLAI and 15.9% with aripiprazole patients. Tolerability was generally good for both treatment groups. Weight gain (7.0% with RLAI vs. 4.4% with aripiprazole), extrapyramidal adverse events (AEs) (10.3% vs. 4.4%), and potentially prolactin-related AEs (4.6% vs. 0%) were more common with RLAI treatment, and gastrointestinal disorders were more common in aripiprazole-treated patients (22.2% vs. 6.1%). Time-to-relapse in stable patients with schizophrenia or schizoaffective disorder was numerically longer in RLAI-treated patients than in aripiprazole-treated patients although not statistically significant. Both treatments were generally well tolerated.

Routine laboratory screening among newly admitted psychiatric patients: is it worthwhile?

OBJECTIVE: This study compared the prevalence of abnormal results of laboratory tests routinely performed among newly hospitalized psychiatric patients in Spain and the cost-effectiveness of such tests. METHODS: Routine biochemical tests were performed for 510 newly hospitalized psychiatric patients. For all tests, this study examined the prevalence of values outside the normal range and compared the number needed to screen to find one abnormal result (NNSAR=1/prevalence of abnormal results in the studied population) with the direct cost spent to find one abnormal result (DCSAR=NNSAR x direct cost per test). RESULTS: The prevalence of values outside the normal range ranged from 1% for free thyroxine (FT4) to 36% for total cholesterol. The NNSAR ranged from 2.8 for total cholesterol to 127.3 for FT4. The DCSAR ranged from .38 international dollars of 2000 (I$) for chloride to 402.27 I$ for FT4. CONCLUSIONS: There were large differences in the prevalence of abnormal results (NNSAR) and cost-effectiveness (DCSAR) for the laboratory tests routinely performed among newly admitted psychiatric patients.